Fillable Orange&RocklandSTEMClassroomGrants CoverSheetandApplication Deadlinefor2021-2022SchoolYear:June 1, 2021 Thiscoversheetmustbeattachedtoyourapplication. Applicationmaybesentelectronicallyorbymailwith su

Fill Online, Printable, Fillable, Blank Orange&RocklandSTEMClassroomGrants CoverSheetandApplication Deadlinefor2021-2022SchoolYear:June 1, 2021 Thiscoversheetmustbeattachedtoyourapplication. Applicationmaybesentelectronicallyorbymailwith su Form

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Orange&RocklandSTEMClassroomGrants CoverSheetandApplication Deadlinefor2021-2022SchoolYear:June 1, 2021 Thiscoversheetmustbeattachedtoyourapplication. Applicationmaybesentelectronicallyorbymailwith supportingdocumentationtotheemailormailingaddress (Orange & Rockland)

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The Orange&RocklandSTEMClassroomGrants CoverSheetandApplication Deadlinefor2021-2022SchoolYear:June 1, 2021 Thiscoversheetmustbeattachedtoyourapplication. Applicationmaybesentelectronicallyorbymailwith su form is 3 pages long and contains:

2 signatures
2 check-boxes
22 other fields

Country of origin: US
File type: PDF

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1

Nameofapplicant:______

_______________________________________________________________

Nameofschool/organization:____________________________________________________________

Addressofschool/organization:Street_____________________________________________________

City____________________________________State________County______________Zip___________

School/organizationtelephone:__________________________________________________________

Applicant’semailaddress:_______________________________________________________________

Applicant’shometelephone:_____________________________________________________________

Grade(s)andsubject(s)taught:___________________________________________________________

IunderstandthatallgrantsandtheamountawardedshallbeatthediscretionofOrangeandRocklandUtilities,Inc.andits

EducationAdvisoryCouncil.Ifurtherunderstandthat,intheeventIamawardedagrantfortheprojectdescribedhere,

OrangeandRocklandUtilities,Inc.shallhavetherighttosupplyotherswithadescriptionofmyprojectandtheunderlying

conceptsandidea.PleaseattachacopyofyourSchoolorOrganization’s“RequestforTaxpayerIdentificationForm”(IRS

FormW‐9)and501(c)(3)determinationletterorequivalentwiththisapplication.Failuretodosomaydisqualifyyour

application.

Applicant’sSignature:___

_____________________________________Date:______________________

Principal/Supervisor’sName:(PleasePrint)__________________________________________________

Principal/Supervisor’sSignature:________________________________Date:_____________________

Grade(s)andsubject(s)taught:___________________________________________________________

Pleasecompleteallsidesofthisapplication,attachdocumentationandemailtofegerl@oru.comormailto:

Orange&Rockland

OneBlueHillPlaza–4

Floor

PearlRiver,NY10965

Attn:LindaFeger

Orange&RocklandSTEMClassroomGrants

CoverSheetandApplication

Deadlinefor2021-2022SchoolYear:June 1, 2021

Thiscoversheetmustbeattachedtoyourapplication.

Applicationmaybesentelectronicallyorbymailwith

supportingdocumentationtotheemailormailingaddress

below.

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

2



ThefollowingformatmustbeusedtoapplyfortheOrange&RocklandSTEMClassroomGrants.

Allsectionsmustbecompleted.Failuretodosowilldisqualifyyourapplication.



TitleofProject: 



1. Approximatelyhowmanystudentsinyourclassroomwillparticipateinthisproject: 



2. Pleaseprovideabriefsummaryoftheclassroomprojectandincludethemajorobjectives.



3. Howwillyouevaluateachievementofyourprogramobjectives?



3



4. Doestheprojectincorporatematchingfunds? Yes No

Describe:  



  

5. Itemizetheexpendituresneededtocompletetheproject.Includeinformationonthematerialsand

equipmentneeded,supplierandcost.Pleasebespecific.



6. Whatisthetotalamountofyourrequest?(Maximum$1,000) $

Fillable Orange&RocklandSTEMClassroomGrants CoverSheetandApplication Deadlinefor2021-2022SchoolYear:June 1, 2021 Thiscoversheetmustbeattachedtoyourapplication. Applicationmaybesentelectronicallyorbymailwith su

Fill Online, Printable, Fillable, Blank Orange&RocklandSTEMClassroomGrants CoverSheetandApplication Deadlinefor2021-2022SchoolYear:June 1, 2021 Thiscoversheetmustbeattachedtoyourapplication. Applicationmaybesentelectronicallyorbymailwith su Form

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